No. Use February 28 of the measurement year when identifying the Age of the member for Rate 1 and Rate 2. NCQA does not make changes that impact software programming after the release of the Technical Update memo.
HEDIS 2017
FAQ Directory: HEDIS
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10.15.2016 Follow-Up After Care for Children Prescribed ADHD Medication In the Technical Update memo, the reference to “February 28” in the Intake Period definition was replaced with “February 29” because 2016 is a leap year. Should organizations make the same change to the “Ages” criteria in the Eligible Population of Rate 1 and Rate 2?
10.15.2016 October Release of the HEDIS 2017 Value Set Directory Where can I find the October 3 version of the HEDIS 2017 Volume 2 Value Set Directory?
The updated Value Set Directory (VSD) is available to customers who purchased HEDIS 2017 Volume 2. Go to the NCQA Download Center to obtain the file: https://downloads.ncqa.org/customer/Login.aspx.
Note: The updated VSD is not labeled “10-3” in the Download Center. Click “Download” and the file name will include the date 10.03.16.
HEDIS 2017
9.15.2016 Mapping Facilities to Provider Types May an organization map a facility to a provider type for reporting HEDIS measures (e.g., map a Federally Qualified Health Center [FQHC] to the type Primary Care Practitioner (PCP))?
No. Facilities may not be mapped to a provider type unless an organization can demonstrate that all providers rendering services at the facility meet the NCQA provider definition defined in Appendix 3. Organizations should work with their HEDIS Compliance Auditor, who can review and approve mapping.
HEDIS 2017
9.15.2016 Direct Transfers In a “direct transfer,” the discharge date from one inpatient setting and the admission date to a second inpatient setting are one calendar day apart or less. May the admission date from the second inpatient setting take place on the day before the discharge date from the first setting?
9.15.2016 ED/Observation Visits Resulting in an Inpatient Stay Many measures instruct organizations to not include ED visits or observation visits that result in an inpatient stay. The ED visit or observation visit results in an inpatient stay when the ED/observation date of service and the admission date for the inpatient stay are one calendar day apart or less. May the inpatient admission take place on the day before the ED or the observation visit date?
7.15.2016 Standardized Healthcare-Associated Infection Ratio Will NCQA post an example HAI Standardized Infection Ratio (SIR) table to be used when reporting the Hospital Acquired Infection (HAI) measure?
Yes. NCQA posted an example HAI SIR table to the HEDIS 2017 Web site at http://www.ncqa.org/hedis-quality-measurement/hedis-measures/hedis-2017. The final HAI SIR table (Table HSIR) will be posted to the NCQA Web site by January 2, 2017.
HEDIS 2017
3.15.2016 Expected Counts in IDSS for IHU, EDU and HPC How should the Expected counts be reported in IDSS for Inpatient Hospital Utilization, Emergency Department Utilization and Hospitalization for Potentially Preventable Complications? Do they need to be rounded?
2.24.2016 Digital Mammography for Breast Cancer Screening Is digital mammography included in the HEDIS® Breast Cancer Screening Measure?
The HEDIS® 2016 Breast Cancer Screening (BCS) measure aligns with the 2009 US Preventive Services Task Force (USPSTF) guidelines. The guideline concluded the evidence was insufficient to assess the additional benefits and harms of digital mammography instead of film mammography for breast cancer screening. NCQA understands mammography practice, coding and technology have evolved over time to include digital mammography, and the current HEDIS measure includes CPT codes that represent either traditional mammography or digital mammography and cannot be delineated through administrative reporting. However, three HCPCS G codes, specific to digital mammography, were inadvertently included in the Mammography Value Set. Because the HEDIS 2016 specifications are frozen, NCQA will allow plans to follow the current measure specification and associated value sets as written.
The measure will be evaluated for HEDIS 2017 and the value-sets will be updated accordingly based on newly released USPSTF Guideline recommendations.
HEDIS 2016
1.15.2016 Statin Therapy for Patients With Cardiovascular Disease and Statin Therapy for Patients With Diabetes Are all members who are numerator compliant for Rate 1 used as the eligible population for Rate 2 in the Statin Therapy for Patients With Cardiovascular Disease (SPC) and Statin Therapy for Patients With Diabetes (SPD) measures?
Yes. All members who are numerator compliant for Rate 1 must be used as the eligible population for Rate 2 in both the SPC and SPD measures (regardless of the data source used to capture the Rate 1 numerator). For example, if supplemental data were used to identify compliance for the Rate 1 numerator, then supplemental data will be included in identifying the Rate 2 eligible population.
If pharmacy data are the source data, and are treated similar to encounter data, they could be classified as encounter data rather than as supplemental data. For example, if a pharmacy benefit manager (PBM) offers the pharmacy benefit on behalf of a health plan and regularly sends pharmacy data to the plan in a standard format, the data could be considered to be encounter data. Organizations must work with their auditor to determine how data are classified. The auditor will review the organization’s pharmacy benefit structure and the processes for receiving and using data when determining the classification.
HEDIS 2016
1.15.2016 Use of Multiple Concurrent Antipsychotics in Children and Adolescents May we use supplemental data to report the Use of Multiple Concurrent Antipsychotics in Children and Adolescents (APC) measure?
No. Because supplemental data may not be used to identify the eligible population, and the same events are used for the denominator and numerator in APC, supplemental data may not be used for this measure. The data elements table in Volume 2 for APC inadvertently includes the “Numerator events by supplemental data” data element. This field will not be included in the IDSS.
HEDIS 2016
1.15.2016 Care for Older Adults Are CMS Medicare-Medicaid Plans (MMPs) required to report the SNP-only measure, Care for Older Adults (COA), for HEDIS 2016?
1.15.2016 Comprehensive Diabetes Care The urine protein testing requirements for the Medical Attention for Nephropathy indicator were revised. Some examples in HEDIS 2015 (e.g., urine dipstick) are not listed in the 2016 specifications, so do urine dipsticks and test strips still meet criteria for this indicator for HEDIS 2016?
Yes. As a result of changes to the measure, the two example lists were combined into a single list to remove redundancy. All examples that met criteria in HEDIS 2015 meet criteria for HEDIS 2016. Urine dipsticks are considered “spot urine” tests so they meet criteria based on the example, “Spot urine for albumin or protein.”
HEDIS 2016